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Allergens & environment
Bakery and pastry work: occupational respiratory allergies and dermatitis
Flour, enzymes, hands, nose and airways: identify the link with work early
In bakery and pastry work, flour dust, enzymes and other ingredients may cause rhinitis, asthma, hives or protein contact dermatitis. Hand eczema may also be irritant or result from delayed contact allergy. Identifying the mechanism helps select the right tests and preventive measures.
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Three essential points
1. Flour plus nose or airway symptoms are not necessarily simple irritation
Sneezing, a blocked or runny nose, cough, wheezing or breathlessness occurring at work should prompt investigation for work-related rhinitis or asthma. Improvement on days off or during holidays is an important clue.
2. Hand eczema may have several mechanisms
Irritant dermatitis, delayed contact allergy, contact hives and protein contact dermatitis may look similar. The clinical history and choice of tests are essential.
3. Patch tests and skin prick tests do not investigate the same process
Patch tests mainly investigate delayed allergy. Skin prick or prick-to-prick tests look for immediate sensitisation, particularly to flour and other proteins. Patch tests may be negative in protein contact dermatitis.
Why does bakery work involve so much exposure?
- Situation
- Weighing / opening bags
- Possible exposure
- Clouds of flour and powdered mixes.
- Situation
- Filling the mixer / kneading
- Possible exposure
- Flour becoming airborne again.
- Situation
- Dusting / shaping
- Possible exposure
- Flour dust close to the airways.
- Situation
- Cleaning
- Possible exposure
- Dust becoming airborne again when dry sweeping or using compressed air.
- Situation
- Pastry / viennoiserie
- Possible exposure
- Egg, milk, soy, lupin, seeds, tree nuts and other proteins depending on recipes.
- Situation
- Improvers
- Possible exposure
- Baking enzymes, particularly fungal alpha-amylase.
| Situation | Possible exposure |
|---|---|
| Weighing / opening bags | Clouds of flour and powdered mixes. |
| Filling the mixer / kneading | Flour becoming airborne again. |
| Dusting / shaping | Flour dust close to the airways. |
| Cleaning | Dust becoming airborne again when dry sweeping or using compressed air. |
| Pastry / viennoiserie | Egg, milk, soy, lupin, seeds, tree nuts and other proteins depending on recipes. |
| Improvers | Baking enzymes, particularly fungal alpha-amylase. |
The main allergens to know
- Family
- Cereals
- Examples / message
- Wheat, rye, barley, oats and maize; depending on recipes: buckwheat, soy and lupin.
- Family
- Enzymes
- Examples / message
- Mainly fungal alpha-amylase; other enzymes depending on the improvers used.
- Family
- Other food proteins
- Examples / message
- Egg, milk, sesame or other seeds, tree nuts, yeast and other ingredients actually handled.
| Family | Examples / message |
|---|---|
| Cereals | Wheat, rye, barley, oats and maize; depending on recipes: buckwheat, soy and lupin. |
| Enzymes | Mainly fungal alpha-amylase; other enzymes depending on the improvers used. |
| Other food proteins | Egg, milk, sesame or other seeds, tree nuts, yeast and other ingredients actually handled. |
Occupational asthma or work-exacerbated asthma?
- Situation
- Occupational asthma
- What to understand
- Work caused the asthma to develop through sensitisation or occupational exposure.
- Situation
- Work-exacerbated asthma
- What to understand
- The asthma already existed, but dust, flour, irritants, heat or physical effort at work make it worse.
| Situation | What to understand |
|---|---|
| Occupational asthma | Work caused the asthma to develop through sensitisation or occupational exposure. |
| Work-exacerbated asthma | The asthma already existed, but dust, flour, irritants, heat or physical effort at work make it worse. |
Work and rest pattern: a major clue
How is a suspected respiratory condition investigated?
- Test
- Spirometry / pulmonary function tests (PFTs)
- What it provides
- Look for airflow obstruction and variability; FEV1 is measured by spirometry.
- Test
- Skin prick tests
- What it provides
- May identify immediate sensitisation to the flour actually handled and, depending on the context, to certain enzymes or other proteins.
- Test
- Specific IgE
- What it provides
- May help for wheat, rye, alpha-amylase and other allergens available through the laboratory.
- Test
- Peak-flow diary (PEF)
- What it provides
- When prescribed and medically interpreted, this may document differences between periods at work and away from work.
- Test
- Specialist investigations
- What it provides
- Bronchial hyperresponsiveness testing or specific challenge testing in some centres, when required.
| Test | What it provides |
|---|---|
| Spirometry / pulmonary function tests (PFTs) | Look for airflow obstruction and variability; FEV1 is measured by spirometry. |
| Skin prick tests | May identify immediate sensitisation to the flour actually handled and, depending on the context, to certain enzymes or other proteins. |
| Specific IgE | May help for wheat, rye, alpha-amylase and other allergens available through the laboratory. |
| Peak-flow diary (PEF) | When prescribed and medically interpreted, this may document differences between periods at work and away from work. |
| Specialist investigations | Bronchial hyperresponsiveness testing or specific challenge testing in some centres, when required. |
A peak-flow diary: useful in some situations
Peak flow measures PEF (peak expiratory flow), not FEV1. Under medical supervision, repeated measurements several times a day during periods at and away from work may help document the effect of work.
The occupational physician: essential
Do not leave your occupation solely because of a positive test. The occupational physician can assess the workstation, identify the highest-exposure tasks, review formulations and safety data sheets, suggest adjustments and help support continued employment.
Four hand conditions to distinguish
- Problem
- Irritant dermatitis
- Typical appearance
- Dryness, cracks, burning and redness.
- Most useful investigation
- History, examination and exposure assessment.
- Problem
- Allergic contact dermatitis
- Typical appearance
- Delayed eczema after sensitisation.
- Most useful investigation
- Patch tests.
- Problem
- Contact hives
- Typical appearance
- Rapid wheals or swelling after contact.
- Most useful investigation
- Skin prick / prick-to-prick testing depending on the context.
- Problem
- Protein contact dermatitis
- Typical appearance
- Chronic hand eczema with rapid flares after protein contact.
- Most useful investigation
- Skin prick / prick-to-prick testing; patch tests may be negative.
| Problem | Typical appearance | Most useful investigation |
|---|---|---|
| Irritant dermatitis | Dryness, cracks, burning and redness. | History, examination and exposure assessment. |
| Allergic contact dermatitis | Delayed eczema after sensitisation. | Patch tests. |
| Contact hives | Rapid wheals or swelling after contact. | Skin prick / prick-to-prick testing depending on the context. |
| Protein contact dermatitis | Chronic hand eczema with rapid flares after protein contact. | Skin prick / prick-to-prick testing; patch tests may be negative. |
Protein contact dermatitis: do not miss it
This resembles chronic hand eczema, but contact with the responsible protein may rapidly cause itching, redness, hives or small blisters. Food-handling occupations are particularly affected. Flour and cereals, as well as egg, milk, some seeds or enzymes, may be involved depending on the tasks performed.
Which skin tests?
- Test type
- Patch tests
- When should it be considered?
- Suspected delayed contact allergy: European baseline series (EBS) plus an occupational series suited to food-handling work, then products actually used when relevant.
- Test type
- Skin prick / prick-to-prick tests
- When should it be considered?
- Suspected contact hives or protein contact dermatitis: flour and proteins actually handled, guided by the clinical history.
- Test type
- Workstation / safety data sheet assessment
- When should it be considered?
- Essential for determining what flour, mixes, improvers, disinfectants and gloves actually contain.
| Test type | When should it be considered? |
|---|---|
| Patch tests | Suspected delayed contact allergy: European baseline series (EBS) plus an occupational series suited to food-handling work, then products actually used when relevant. |
| Skin prick / prick-to-prick tests | Suspected contact hives or protein contact dermatitis: flour and proteins actually handled, guided by the clinical history. |
| Workstation / safety data sheet assessment | Essential for determining what flour, mixes, improvers, disinfectants and gloves actually contain. |
Before the consultation: bring what really helps
List and photographs of flour bags · brands and references of mixes · composition of improvers and enzymes · seeds and powders used · cleaning and disinfection products · glove type · safety data sheets if available · photographs of lesions · previous PFTs · timing and delay of symptoms.
Prevention: reduce dust first
- Reduce dust emissions at source: use gentle handling, enclosed or covered systems and local exhaust ventilation where available.
- Put water into the mixer before flour and place flour close to the bottom instead of throwing it in from a height.
- Limit flour dusting and choose less dusty techniques or products where possible.
- Clean with a suitable vacuum; avoid dry sweeping and compressed air, which make flour airborne again.
- For the hands: reduce wet work, use gloves suited to the task and protect the skin barrier regularly.
Recognition and compensation as an occupational disease
- Situation
- Occupational rhinitis / asthma
- French framework
- French occupational disease table RG 66 includes, in particular, aerosolised proteins and work involving exposure to flour; the diagnosis and criteria must be documented.
- Situation
- Allergic contact dermatitis
- French framework
- French table RG 65 may apply depending on the allergen and recognition criteria.
- Situation
- Conditions related to certain enzymes
- French framework
- French table RG 63 may apply in some situations.
- Situation
- Process
- French framework
- The doctor issues the initial medical certificate and the claim is sent to the French local Health Insurance Fund (CPAM). The occupational physician or an occupational disease clinic can help identify the appropriate framework.
| Situation | French framework |
|---|---|
| Occupational rhinitis / asthma | French occupational disease table RG 66 includes, in particular, aerosolised proteins and work involving exposure to flour; the diagnosis and criteria must be documented. |
| Allergic contact dermatitis | French table RG 65 may apply depending on the allergen and recognition criteria. |
| Conditions related to certain enzymes | French table RG 63 may apply in some situations. |
| Process | The doctor issues the initial medical certificate and the claim is sent to the French local Health Insurance Fund (CPAM). The occupational physician or an occupational disease clinic can help identify the appropriate framework. |
Common myths
- Myth
- ‘Flour only causes irritation.’
- SOS Allergo message
- False: it may also cause genuine IgE sensitisation.
- Myth
- ‘A positive wheat skin prick test proves occupational asthma.’
- SOS Allergo message
- No: sensitisation and occupational disease are different.
- Myth
- ‘Negative patch tests mean no skin allergy.’
- SOS Allergo message
- False, particularly for protein contact dermatitis.
- Myth
- ‘My asthma existed before, so work cannot be involved.’
- SOS Allergo message
- False: asthma may be exacerbated by work.
- Myth
- ‘Peak flow measures my FEV1.’
- SOS Allergo message
- No: it measures PEF.
- Myth
- ‘If it is occupational, I must stop immediately.’
- SOS Allergo message
- Not automatically: diagnosis, prevention and continued employment should be discussed.
| Myth | SOS Allergo message |
|---|---|
| ‘Flour only causes irritation.’ | False: it may also cause genuine IgE sensitisation. |
| ‘A positive wheat skin prick test proves occupational asthma.’ | No: sensitisation and occupational disease are different. |
| ‘Negative patch tests mean no skin allergy.’ | False, particularly for protein contact dermatitis. |
| ‘My asthma existed before, so work cannot be involved.’ | False: asthma may be exacerbated by work. |
| ‘Peak flow measures my FEV1.’ | No: it measures PEF. |
| ‘If it is occupational, I must stop immediately.’ | Not automatically: diagnosis, prevention and continued employment should be discussed. |
Final message
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More from SOS Allergo
Asthma · Rhinitis and rhinoconjunctivitis · Eczema and contact dermatitis · Laboratory tests in allergology · Skin prick tests / patch tests · Occupational allergy · Anaphylaxis
References and resources
- Jeebhay MF, Moscato G, Bang BE, et al. Food processing and occupational respiratory allergy - an EAACI position paper. Allergy. 2019;74(10):1852-1871. doi:10.1111/all.13807.
- Vandenplas O, Doyen V, Raulf M. Occupational Respiratory Allergy to Flour in the Modern Era. Curr Allergy Asthma Rep. 2025;25(1):22. doi:10.1007/s11882-025-01204-x.
- Barbaud A, et al. Occupational protein contact dermatitis. Eur J Dermatol. 2015;25:527-534.
- Barbaud A. Mechanism and diagnosis of protein contact dermatitis. Curr Opin Allergy Clin Immunol. 2020;20:117-121.
- INRS. Dermatite de contact aux protéines, TA 102 ; Tableaux RG 66, RG 65 et RG 63 des maladies professionnelles.
- INRS. Prévention des risques en boulangerie-pâtisserie : réduction des poussières de farine et organisation du travail.
This information sheet does not replace medical consultation or assessment by the occupational physician. Investigations, prevention and occupational procedures must be tailored to the individual situation.
Scientific review: September 2026 · sosallergo.fr
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